MEDICARE: CITY OF NORTH WILDWOOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	NONE	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1051359	OTHER	NJ	KEYSTONE MERCY HEALTH PLN
2	6735207	OTHER	NJ	AMERIGROUP
3	0822149000	OTHER	NJ	AMERIHEALTH
4	0532402	OTHER	NJ	US HEALTHCARE
5	1051359	OTHER	NJ	HORIZON MERCY
6	NL2054	OTHER	NJ	HEALTHNET
7	21177	OTHER	NJ	SENIOR PARTNERS
8	90000596900	OTHER	NJ	AMERICHOICE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	0822149000	OTHER	NJ	AMERIHEALTH ADMINISTRATOR
11	21177	OTHER	NJ	HEALTH PARTNERS TN

General Provider Information

NPI Number	:	1477653319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF NORTH WILDWOOD

Provider Business Mailing Address
First Line	:	400 NEW JERSEY AVE
Second Line	:
City	:	NORTH WILDWOOD
State	:	NJ
Zip	:	08260-2917
Country	:	US
Telephone Number	:	609-522-5743
Fax Number	:	609-729-0722

Provider Business Practice Location Address
First Line	:	400 NEW JERSEY AVE
Second Line	:
City	:	NORTH WILDWOOD
State	:	NJ
Zip	:	08260-2917
Country	:	US
Telephone Number	:	609-522-5743
Fax Number	:	609-729-0722

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	PAUL EVANGELISTA
Credential	:
Telephone Number	:	609-522-5743

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	06/20/2008

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1982652731 — DR. MARY ANN HAFLIN MD
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1649228339 — DR. RONALD J GELZUNAS DO
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1942383575 — NEW JERSEY CVS PHARMACY LLC
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Directions to “CITY OF NORTH WILDWOOD ” Practice Location

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